Profile and outcomes of referred neonates needing immediate resuscitation at admission

Background: Referral of sick newborns to a tertiary centre for management is common. Deterioration in the baby’s condition can occur during transport and affects the outcome of babies. Many babies reach the referral centre in an unstable condition and need resuscitation immediately on arrival in the emergency. We aimed to study the profile and outcomes of such babies. Methods: This prospective observational study over a period of 8 months aimed at understanding the profile and demographic characters of neonates needing immediate resuscitation at admission and analysing their outcomes. We included all neonates who were resuscitated at admission and followed their hospital course until discharge or death. Results: A total of 133 (21%) of all the referred babies who fulfilled the inclusion criteria were enrolled. Most of the babies were male, born at term and were less than 24 h old. Ambulances were the mode of transport for 117 (88%) babies. Mortality was seen in 68 (51.1%) babies with 36 (52.9%) deaths occurring within 24 hours of admission. Need for inotropes at admission was strongly associated with mortality, the relative risk being 5.30 with a confidence interval of (2.3, 12). Age<48 hours and distance travelled >15 km were also associated with high risk of mortality. Conclusions: Neonates needing immediate resuscitation at admission have high rates of mortality. Factors like shock at admission, distance travelled, and age of the baby should be considered and taken into account before a baby is referred to another centre for management. Risk factors associated with poor outcomes should be considered and managed before and during transport.